Infection with human immunodeficiency virus (HIV) may lead to hemostatic imbalances. Forty-nine consecutive patients with acute opportunistic infections were screened for thrombophilic parameters. A follow-up investigation was performed after 10 8 weeks in 26 patients. In acutely ill patients, the incidence of protein S deficiency was 67% (33/49) and of protein C deficiency 25% (12/49), while at the follow-up visit the incidences were 54% (14/26) and 8% (2/26), respectively. Protein S and protein C levels increased significantly from initial to follow-up visit (p < 0.05). Lupus anticoagulants were not detected and anticardiolipin IgG antibodies were present in 11.4% (5/44). Three patients presented with deep venous thrombosis on admission; in two, protein S or protein C deficiency was observed. In conclusion, an acquired protein S and protein C deficiency often develop in patients with HIV and acute illness; this may be reversible after treatment for opportunistic infections.
1. Fair DS, Marlar RA. Biosynthesis and secretion of factor VII, protein C, protein S, and protein C inhibitor from a human hepatoma cell line. Blood1986;67:64-64.
2.
2. Vincenot A, Gaussem P.Physiology and cellular regulation of the protein C system. Ann Biol Clin1997;55 (1):17-17.
3.
3. Shets SB, Carvalho AC.Protein S and C alterations in acutely ill patients. Am J Hematol1991;36:14-14.
4.
4. Allaart CF, Poort SR, Rosendaal FR, et al. Increased risk of venous thrombosis in carriers of hereditary protein C deficiency defect. Lancet1993;341:134-134.
5.
5. Dolan G, Ball J, Preston FE. Protein C and protein S. Baillieres Clin Haematol1989;2:999-999.
6.
6. Heijboer H, Cogo A, Builler HR, Prandoni P, ten Cate JW. Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep vein thrombosis. N Engl J Med1990;323:1512-1512.
7.
7. van der Meer FJ, Koster T, Vandenbroucke JP, Briet E, Rosendaal FR. The Leiden Thrombophilia Study (LETS). Thromb Haemost1997;78:631-631.
8.
8. D'Angelo AD, Vigan-D'Angelo S, Esmon CT, Comp PC. Acquired deficiencies of protein S. Protein S activation during oral anticoagulation, in liver disease, and in disseminated intravascular coagulation. J Clin Invest1988;81:1445-1445.
9.
9. Lafeuillade A, Alessi MC, Poizot-Martin I, Dhiver C, Quilichini R, Aubert L, Juhan-Vague I, Gastaut JA.Protein S-deficiency and HIV-infection. N Engl J Med1991;25:1220-1220.
10.
10. Stahl CP, Wideman CS, Spira TJ, Haff EC, Hixon GJ, Evat BL. Protein S deficiency in men with long-term human immunodeficiency virus infection. Blood1993;81:1801-1801.
11.
11. Keeling DM, Campbell SJ, Mackie IJ, Machin SJ, Isenberg, DA.Total and free protein S in systemic lupus erythematodes. Thromb Res1990;60:237-237.
12.
12. Chafa O, Fischer AM, Meriane F, Chellai T, Strenberg C, Otmani F, Benabadji M.Behcet syndrome associated with protein S deficiency. Thromb Haemost1992;67:1-1.
13.
13. Feffer SE, Fox RL, Orsen MM, Harjai KJ, Glatt AE.Thrombotic tendencies and correlation with clinical status in patients infected with HIV. South Med J1995;88:1126-1126.
14.
14. Bissuel F, Berruyer M, Causse X, Dechavanne M, Trepo C. Acquired protein s-deficiency: Correlation with advanced disease in HIV-1-infected patients. J Acq Imm Def Syn1992;5:484-484.
15.
15. Sorice M, Griggi T, Arcieri P, Circella A, d'Agostino F, Ranieri M, Modrzewska R, Lenti L, Mariani G. Protein S and HIV infection, role of anticardiolipin and anti-protein S antibodies. Thromb Res1994;73:165-165.
16.
16. Brew BJ, Miller J.Human immunodeficiency virus type 1-related transient neurological deficits. Am J Med1996;101:257-257.
17.
17. Lafeuillade A, Alessi MC, Poizot-Martin I, Boyer-Neumann C, Zandotti C, Quilichini R, Aubert L, Tamalet C, Juhan-Vague I, Gastaut JA.Endothelial cell dysfunction in HIV infection. JAcq Imm Def Syn1992;5:127-127.
18.
18. Boullanger N, El Kouri D, Trossaert M, Truchaud F, Trewick D, Planchon B. Coagulation activation in patients with an inflammatory syndrome: Is there a link with acquired protein S deficiency?Blood Coag Fibrinol1998;9:167-167.
19.
19. Abuaf N, Laperche S, Rajoely B, Carsique R, Deschamprotein SA, Rouquette AM, Barthet C, Khaled Z, Marbot C, Rozen J, Girard PM, Rozenbaum W. Autoantibodies to phospholipids and to the coagulation proteins in AIDS. Thromb Haemost1997;77:835-835.
20.
20. Qureshi Al, Janssen RS, Karon JM, Weissman JP, Akbar MS, Safdar K, Frankel MR. Human immunodeficiency virus infection and stroke in young patients. Arch Neurol1997;54:1150-1150.
21.
21. Sullivan PS, Dworkin MS, Jones JL, Hooper WC, and the Adult/Adolescenst Spectrum of HIV Disease Project. Epidemiology of thrombosis in HIV-infected individuals. AIDS2000;14:321-321.
22.
22. Sugermann RW, Church JA, Goldsmith JC, Ens GE.Acquired protein S deficiency in children infected with human immunodeficiency virus. Pediatr Infect J1996;15(2):106-106.
23.
23. Chiarantini E, Valanzano R, Liotta AA, Cellai AP, Fedi S, Ilari I, Prisco D, Tonelli F, Abbate R.Hemostatic abnormalities in inflammatory bowel disease. Thromb Res1996;82:137-137.
24.
24. Malia RG, Kitchen S, Greaves M, Preston FE. Inhibition of activated protein C and its cofactor protein S by antiphospholipid antibodies. Br J Haematol1990;76:101-101.
28. Shirai A, Consentino M, Leitman-Klinman SF, Klinman DM.Human immunodeficiency virus infection induces both polyclonal and virus-specific B cell activation. J Clin Invest1992;89:561-561.
29.
29. Schmitz-Huebner U.Epidemiologie der venosen Thrombose und der Lungenembolie. In: Muller-Berghaus G, Potzsch B.Hdmostaseologie.Berlin: Springer, 1999:528-528.
